As a person ages, they generally incur tooth and bone loss requiring prosthetic replacement as provided by the dental profession. One of the more important aspects of this replacement procedure is the need to solidly anchor within the available bone structure those implants used to secure individual (replacement artificial tooth) or collective (e.g., denture) dental prosthetic. When teeth lose bone around their roots, the bone (e.g., mandibular strut or the maxillary strut) may become uneven (either thinned out or too bulky) in various places in the respective dental strut. This bone condition may make the dental restorative process in that particular area more difficult than when such bone loss has not occurred. It could be thought as building a house whose foundation on an unleveled or uneven ground.
In order for the dental prosthetic (or restoration) to be properly fitted to the patient in a substantially esthetically and functionally acceptable position, the dental health care professional (e.g. dental surgeon) may first have to alter the bone of the dental surgical site (especially in those situations where the dental prosthetic is redressing significant tooth loss). This corrective process could start by making one or more incisions in gum area that otherwise designates the dental surgical or restoration site. These incisions substantially allow the gum tissue to be peeled back to expose the bone at the dental surgical site. The dental surgeon, in order to generally make dental surgical site/dental arch symmetrical in all relevant dimensions for the dental restoration (e.g., removable denture) or implant sites (e.g. fixed prosthetics) may then apply one or more cutting tools to generally reduce or remove unwanted high points or thickened places on the exposed bone structure. In other instances, the dental surgeon may add bone material to the exposed bone structure to further fill out the arch's profile or otherwise strengthen its structure.
During this process, the dental surgeon could bring the top portion of the alveolar ridge (e.g., one of the two jaw ridges either on the roof of the mouth or the bottom of the mouth that contain the sockets or alveoli of the teeth) to the correct surgical dimensions (“leveling out”) by utilizing a bone foundation guide generally placed upon and secured to the bone structure to substantially guide the cutting/augmenting of the exposed bone. The bone foundation guide solves the problem of “estimating” the vertical height and width of the bone at the “coronal” level by guiding the surgeon's operation of the cutting tools and/or augmentation of the bone. This allows subsequent and accurate placement of the dental implants and respective prosthetics at the proper patient-specific vertical and horizontal levels. This bone adjustment process may also provide for the creation of the proper inter-occlusal room (e.g., the space that exists between the opposing teeth and the open tissue (e.g., that will receive the dental prosthetic) to generally insure that proper jaw operation and alignment, smile line and phonetics occur when the final dental prosthetic is finally located within the patient's mouth.
After the exposed bone has been properly been prepared (e.g., reduced or augmented), the bone foundation guide may be removed. A dental implant surgical guide may be subsequently fitted and attached in its place at the remodeled bone of dental surgical site. The dental implant surgical guide may be used to guide the operation of implant accessories needed to prepare the dental surgical site to receive the dental implants. The dental implant surgical guide may then be used to suitably locate the dental implants into the prepared bone structure.
After the dental implants are properly located, the dental implant surgical guide may be removed and healing abutments (if required) may be fitted to the dental implants to create a space in the reattached gum proximate to the dental implant(s) that receives a portion (e.g., the base) of prosthetic or prosthesis (e.g., artificial tooth). Once the healing abutments are attached, the gum tissue may sutured back up and around the dental implant-healing abutment combination.
As needed, a full upper or full lower denture/tooth may be fitted to the implants either at the close of the dental surgery or later after healing of the tissues/osseo-integration of bone to implant(s) has occurred. Once the healing/osseo-integration has finalized, the dental surgeon could remove the healing abutments to open up the space proximate to the implants that receives the base of the prosthetic to place and affix the dental prosthetic securely to the implant(s).
The bone foundation guide and the implant dental surgical guide for the implants are generally considered separate instruments that are generally designed, manufactured and used independently of one another other. The design and creation of these guides can be now be accomplished through digital dentistry (e.g., pre-surgical digital methods and associated apparatuses to obtain and merge medical imaging information taken from the patient's mouth and/or dental castings of the patient's mouth to create a patient-specific virtual models of the preoperative and post-operative mouth and a surgical plan connecting the two models) or manually by dental art and hand (e.g., analogue dental design and preparation).
This separation or compartmentalization of dental guide capabilities could result in higher costs, manpower, and surgical time that could be found than if the two dental guides could be combined into one multipurpose device. The use of such a combination dental appliance could accordingly lead to an increase in the affordability of such dental procedures and results.
Another issue that may arise in such dental implant surgeries is when the dental healthcare professionals locate and affix the bone foundation guide physically upon the dental surgical site (e.g., a portion of bone.) Generally, the dental healthcare professional has to juggle both tasks of locating and affixing (e.g., drilling into the bone for fasteners, then using fasteners to secure the bone foundation guide onto bone) at the same time. The dental healthcare professional in having juggling both tasks may not properly locate the bone foundation guide in desired area of the dental surgical site; may not properly secure the bone foundation guide in place or both.
Yet another issue that may arise related to dental implant surgeries on the upper alveolar ridge (e.g., upper jaw) of a patient and in particular those rear portions of the upper alveolar ridge that otherwise may support and secure the molars and premolars, the posterior maxilla. If the patient has suffer significant tooth loss or is totally edentulous (e.g., especially in the posterior maxilla) there may be a tendency for the floor of the maxillary sinus cavity, the maxillary sinus cavity generally being located above the posterior maxillary, to expand and descend downward towards the top of the respective posterior maxilla substantially reducing the amount and thickness of bone in the posterior maxilla. In severe edentulous cases, the posterior maxilla on both sides of the upper jaw, along with other portions of the upper jaw, may substantially recede and contract towards the upper mouth portion (e.g., soft palate.) As a result, there may be insufficient amount of bone in both posterior maxilla sections (e.g., both rear upper jaw areas) to properly anchor any standard jawbone dental implant placed in the posterior maxilla.
One possible remedy could be a sinus lift or a sinus augmentation operation may be performed to augment the top of the posterior maxilla bone with bone graft material. By going through the maxillary sinus, bone graft material can be inserted on top of the posterior maxilla bone to generally allow anchoring standard dental implants at the posterior maxilla portions. However, older dental patients who may not wish to wait for the healing wait time (e.g., needed for bone graft material integration with the posterior maxilla bone); endure the discomfort resulting from such operations or both may wish to pursue alternative implant securing methods.
As substantially shown in FIGS. 33-33C, alternative implant securing methods or processes could involve anchoring of dental implant(s) into remote anchoring site 304, a skull bone structure that is generally considered remote from the patients mouth 19 to substantially position the dental implant's prosthesis attaching end by the respective posterior maxilla 308 (rear portions of the upper alveolar ridge 306.) Generally, there are two types of such remote anchored dental implants: namely a zygomatic (e.g., cheekbone-anchored) dental implant 300 and pterygoid (e.g., skull structure found behind and above the posterior maxilla) dental implant 302. Both zygomatic and pterygoid dental implants 300, 302 are generally significantly longer in length than standard dental implants to allow attachment to the remote anchoring site 304.
The zygomatic dental implant 300 generally could be placed and remotely anchored to the check bone 310 (also known as the zygomatic bone) using three different process: anchoring bone enclosure only process; the partial bone enclosure process and full bone enclosure process. The generally more common of these anchoring processes could be the partial bone enclosure process wherein a portion (e.g., mid-portion) of the zygomatic dental implant 300 generally passes outside of any bone or sinus structures located between the zygomatic bone 310 and the posterior maxilla 308. In this manner, the zygomatic dental implant 300 may pass enter into and through a portion of the posterior maxilla 308; then into and through the maxillary sinus cavity 321; passes out through the bone structure substantially defining the maxilla sinus cavity 321 (and any other proximate bone structure) until the zygomatic dental implant 300 reaches and anchors into the remote anchoring site 304 (e.g., underside of the zygomatic or check bone 310.) The section (e.g., midsection) of the zygomatic dental implant 300 could be laid outside of skull's bone and sinus structure to be generally covered by respective facial tissue and muscle. The prosthesis attachment end of the dental zygomatic implant 300 may generally remain uncovered (e.g., until suitable attachment to a desired dental prosthesis—not shown) to be substantially located at or by the posterior maxilla 308.
The lesser common implant anchoring process could be the anchoring bone enclosure only process. This process could be used when there is an insufficient amount posterior maxilla bone for the zygomatic dental implant 300 to pass through; the zygomatic dental implant's orientation, placement, rotational trajectory require such or other such implant factors may require the zygomatic implant 300 to substantially pass free of the posterior maxilla 308 and maxillary sinus structures for remote site anchoring. In this portion, the zygomatic dental implant's midsection or mid portion generally could be covered by facial tissue and muscle (not shown) until the zygomatic dental implant 300 reaches the patient's mouth 19 to generally locate the zygomatic implant's prosthesis attachment end by, but not necessarily in, the posterior maxilla 308.
The third process or full implant enclosure process could be used where the patient has strong or broad cheek bone structure and may still have significant posterior maxilla structure 308 so that the zygomatic dental implant 300 could be generally introduced through the posterior maxilla 308 and then subsequently through the maxilla sinus cavity 321 to generally pass through skull bone or sinus structure until anchoring into the check bone 310 with the majority of the zygomatic dental implant 300 generally being encompassed by skull bone and sinus structure with the exception of the zygomatic dental implant's prosthesis attachment end. It could be appreciated that one dental prosthesis could be secured to several zygomatic dental implants 300 that are remotely anchored using these various processes.
The pterygoid dental implant 302 may have an implant channel 318 that pass ups through a rear of the ridge of the posterior maxilla 308, through a maxillary tuberosity 312 (e.g., substantially located up from and behind the rear end of the posterior maxilla 308) and into a pterygoid plate 314 (e.g., substantially located adjacent to the back of the maxillary tuberosity 312.) Most of the pterygoid dental implant 302 may be engaged by skull bone structure with the general exception of the pterygoid dental implant's prosthesis attaching end.
One possible problem with anchoring a dental implant into an anchoring site remote from the mouth is that a distance that the dental implant needs to bridge between the prosthesis and the desired remote anchoring site may be significantly greater than a distance needed for a standard upper ridge anchored implant to be anchored within the mouth. This greater distance could correspondingly increase the drilling distance generally needed to create the respective implant channel that the remote anchor implant could go through to reach the remote anchoring site. The greater drilling distance or length of implant channel could increase the degree of error to occur when attempting to terminate the implant channel at the remote implant anchoring site.
Currently, remote anchored implant placement may be done freehand or may be done with the dental implant surgical guide using just one guiding cylinder (e.g., a master tube in a dental implant surgical guide as generally combined with a dental drill key.) Using just one such guiding cylinder to guide the drilling bit could allow the drill bit to drift off target as the drill bit in creating the implant channel moves closer to the remote anchoring site and away from the guidance of the guiding cylinder. The drill bit drift could interfere with the proper implant channel creation (as it generally relates to depth, rotation, trajectory, etc.) and result in missing a desired implant channel entry point at the remote anchoring site location. The missed anchoring point could cause the prosthesis securing end of the remote dental implant to be placed outside the desired orientation, telemetry, rotation and the like as generally needed for proper attachment to the dental prosthesis. Although such a remote dental implant misalignment could be corrected by an angled abutment, such a solution could still result in the patent having a noticeable and awkward feeling in the mouth. Further, substantial drill bit drift could result in unwanted physical damage to the patient ranging from the serious interference with muscular, vascular, skeletal, nerve and vison operations (e.g., for the zygomatic dental implant-drilling into and significantly damaging the associated eye, possibly resulting in blindness; for the pterygoid dental implant-drilling into an artery with possible arterial rupture and patient bleed-out.)
What could be needed to generally reduce the occurrence of such drill bit drift could be the present invention, namely a bone foundation guide system generally comprising an in tandem alignment of multiple, spaced guiding cylinders (e.g., master tubes, dental drill keys or both) substantially supported by a combination of artificial structures (e.g., bone foundation guide, dental implant surgical) or a combination of natural structure(s) (e.g., a perforated posterior maxilla's exposed bone holding a dental drill key) and artificial structure(s) to substantially form a placement channel to guide the subsequent creation of an implant channel through portions of the upper jaw, remainder portions of the skull or both to properly reach the desired dental implant anchoring site remote from mouth.
Multiple tandemly aligned guiding cylinders as held by the combination of structures could form a placement channel that could substantially have a greater length and precision than if the placement channel was formed by only one such structure (e.g., dental implant surgical guide) having only one guiding cylinder through which the placement channel passes or if otherwise done free hand without benefit of any guiding cylinder. Each guiding cylinder so held in tandem combination with other guiding cylinders could provide a precision crafted guide for controlling the orientation, telemetry, positioning and alike of a drill bit passing through the formed placement channel to generally create an implant channel that properly terminates in the remote implant anchor site. Further, such a formed placement channel, by rough analogy, could be similar to a gun barrel having two aiming sights. Increasing length of the placement channel, passing the implant channel through multiple tandemly aligned, spaced-apart guiding cylinders could substantially increase the precision of the drill bit delivery through bone, sinus and alike skull structure to create a resulting implant channel that accurately terminates in the desired area of the implant anchoring site and promotes the desired remote dental implant telemetry, orientation and rotation as substantially set by respective attachment at the remote anchoring site.